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Romania 1 – Legal protection for workers in the case of disability and oncological conditions. In connection with its accession to the European Union on 1 January 2007, Romania has made a determined effort to meet European standards in terms of legal protection for people with disabilities. In particular, in 2006, the government introduced a series of measures on the basis of specific European Union directives. Their implementation, however, is being called into question, reflecting a lack of real commitment on the part of stockholders, union representatives and politicians. In 2002, as a result of the health care restructuring following the overthrow of the regime, the national health system covered only 3% of medical expenses. Full medical cover was provided only in the event of certain diseases, such as tuberculosis and cancer. Romania has 21 million inhabitants, and the number of occupational health officers / company medical officers is somewhere around 350 (consider, for instance, that in France they are approximately 7000). In addition, general practitioners with some competence in occupational medicine are only 2000 (source: Occupational Physician – A Romanian occupational physician’s perspective - http://www.physician.ro/ , December 2007). In general, this professional figure is a practitioner who has a private agreement with the employer. They do not have a fixed working time, even though the number of patients to be treated can be considerable. Only large enterprises employ a medical officer to look after their employees on an exclusive basis. In some cases, they are given responsibility by the government for verifying workers’ health and safety. The law provides that workers classified as being at high risk should undergo medical examinations each year. In small and medium-sized enterprises, however, this does not happen, and job applicants are required to undergo medical examinations only at the time of hiring. Medical officers can also help to evaluate occupational risk, even though it is not within their province. In the event of sickness or injury, the law provides also that the worker maintains his/her position, unless there is a need to employ another worker during his/her absence, to carry out the same task. At a practical level, therefore, there is no legal protection for sick workers. In any case, however, it is possible to apply for sickness benefit. 2 – Specific Legal Protection for people with cancer. Not available 3 – Specific Legal Protection for women with breast cancer Not available - Bargaining Not Available - Case Law Not Available - National Best Practices For people with cancer: Cancer is the second leading cause of death in Romania, and two-thirds of cases are diagnosed only after it has entered the terminal stage (data: 2002). In formal terms, the 1980 Cancer Prevention and Control National Programme provides people with cancer with several means to combat the disease, such as preventive measures, early diagnosis and effective medical treatment. However, the government has been deficient in the provision of basic palliative care, as provided for in the 2002 WHO directives for developing countries. For this reason, non-governmental palliative care organisations, such as Brasov-based Casa Sperantei Hospice, have rapidly developed. The Casa Sperantei Hospice works in cooperation with a UK Hospice, providing training courses on palliative care. It is expected to develop into a centre of excellence for medical research, supporting the National Resource and Training Center in the training of experts in oncological diseases. Furthermore, since the end of 2000, it has been acknowledged as one of the five most important Regional Resource and Training Centers in South Eastern Europe, not to mention the fact it is partially funded by New York-based Open Society Institute, and it also cooperates with the United States National Hospice and Palliative Care Organization (source: Daniela Mosoiu, MD Hospice Casa Sperantei and National Association for Palliative Care, Brasov, Romania, Romania 2002: Cancer Pain and Palliative Care - Vol. 24 No. 2, August 2002, Journal of Pain and Symptom Management). The Rumanian Cancer League (Liga Româna de Cancer) is a non-profit organisation that has launched several initiatives to combat cancer: - “smoking and cancer” is an “aggressive” anti-smoking campaign addressed to young people, which consists of a special screening program and different approaches to the disease, on the basis of the mortality risk, the patients’ age, and their medical test (http://www.romaniancancerleague.org/en/program-smokingandcancer.php); - “support children with cancer” (http://www.romaniancancerleague.org/en/program-supportchildrenwithcancer.php); - “save your health” is a programme which refers to the thirteen-point code included in the report “Nutrition and the prevention of cancer: a global perspective”, released by the American Institute of Cancer on the basis of more than 4,500 scientific studies (http://www.romaniancancerleague.org/en/program-saveyourhealth.php); - “count on us” (http://www.romaniancancerleague.org/en/program-countonus.php): this programme provides support service to people with cancer, and this kind of medical assistance is extremely important in the event of early discharge from hospital Main long-term objectives are: 1 – to provide sick people and their families with necessary information on oncological pathologies; 2 – to provide home care service; 3 – to provide financial support; 4 – to provide patients and health personnel with transport service; 5 – to provide the doctors specialising in other disciplines and health personnel with a training course on oncological pathologies; 6 – to provide palliative care for terminally ill patients; 7 – to purchase efficient apparatuses for CAT (computer axial tomography), radiotherapy and tumour marker detection, in order to provide better diagnosis and medical treatment. Association of People with cancer in Romania (Asociatia Oncologic Rom) supports people with cancer in their return to work, helping them to acquire new skills. It cooperates with another European organization, EUROPAUOMO, which, on similar lines to EUROPADONNA, is to the forefront in combating prostate cancer, promoting a manifesto aimed at safeguarding people with oncological pathologies. For women with breast cancer: In Romania, especially in rural areas, only a small number of women receive cancer screening, mainly because of ignorance and prejudice against breast cancer. The vast majority of women prefer to ignore the problem, or even not to undergo medical examinations. According to the data reported on the website www.globalkomen.org, today in Romania there are only five apparatuses for mammography, one every two million people, whereas in the USA, for instance, the number of these apparatuses is 8,000. Susan G. Komen’s Global Initiative for Breast Cancer Awareness (http://www.globalkomen.org Global Komen is a US organisation founded in 1982, and the programme is carried out by the Institute of International Education West Coast Center (IIE), which involves Romania, Brazil, Costa Rica, Jordan, Mexico, Ukraine and the United Arab Emirates. The main goal of the programme is to create a dynamic global network of experts with a high level of competence in oncological pathologies, serving as a reference point for women with breast cancer. In this connection, future stakeholders need to receive adequate training, in order to reinforce national policies on the issue, enabling private individuals and organisations to launch prevention and information campaigns. To facilitate their education, a special training system, known as the Course of the Cure has been developed. Patented by Susan G. Komen, it consists of five modules and it can be used in multicultural contexts. The main partner of the project is SECS (Society for Education on Contraception and Sexuality, Bucarest). There are other organisations that support the initiative: - the American International Health Alliance (AIHA), which funded a conference on breast cancer in Bucharest, in October 2002; - Common Destiny: in September 2007, the president of this organisation attended Hungary’s Susan G. Kolmen For the Cure, and she was also sent as a delegate to the international summit “Ignite the Promise: Global Advovate Summit”. At the summit, there were 50 representatives from all over the world, and the discussion regarded breast cancer, global health system, and effective measures for early diagnosis and medical treatment. The Susan G. Komen for The Cure US version of the website provides a very detailed guide on breast cancer. See: http://cms.komen.org/komen/About BreastCancer/TheABCsofBreastCancerGuide/index.htm The Rumanian Cancer League (Liga Româna de Cancer) has launched a specific programme for women with breast cancer, “Save Women” http://www.romaniancancerleague.org/en/program-savewomen.php The programme consists of several points, and aims at: 1 – reducing breast (and genital) cancer incidence and mortality, as well as the cost of medical treatment; 2 – training general practitioners and gynecologists, involving them in the programme; 3 – involving Bucharest and Cluj-Napoca-based oncological institutes, and university medical centers; 4 – creating a center for breast and genital cancer prevention and early diagnosis, which cooperates with the league itself, supporting sick women with low income; 5 – treating patients with precancerous lesions; 6 – providing support after therapy and facilitating reintegration into the social and professional environment; 7 – collecting funds to support the main activities. Further Information Rumanian Cancer League Piaţa Romană Nr. 9, Sc. B, Et. 2 Ap. 8, 010372 Sect. 1 Bucuresti, Romania Phone: +40.21-314.69.23 , +40.21-314.69.33 Fax: +40.21-314.69.33 Email: [email protected] Web: http://www.romaniancancerleague.org Fiscal Code: 11607696 National Cancer Prevention Association 3 Aleea Scolii Galati City Galati County - Romania Tel: +40 236 32 11 99 / Fax: +40 236 32 11 99 E-mail: [email protected] Association of People with Cancer in Romania Contact: Corina Alexandru Address 1.: Constanta-head office Soveja street62 Bl.R sc.C ap.58 Tel./Fax. 1.: +40 241 699 199 Address 2.: Spitalul Judetean Clinic de Urgenta Tomis street 142 Constanta Tel./Fax. 2.: 0040.241.699009 E-mail: [email protected] Statistics: Analysis of the processed 2006 Eurostat data. Mortality for cancer (standardised data considering 1.000.000 cases) 1995 1996 1997 1998 1999 1668 0,167% 2002 2003 2004 2005 2006 Romania % Variation 2001 2000 1716 0,172% 0,005% 1760 0,176% 0,004% 1774 0,177% 0,001% 1777 0,178% 0,000% 2006 Eurostat data progress chart. Mortality for cancer (standardised data considering 1.000.000 cases) Romania Cases on 1.000.000 1800 1750 1700 1650 1600 1999 2000 2001 years 2002 2003